GRACE IQBAL
Subscriber on policy B07M000730
Claims
1
Attributed to this person
Charged
892.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
133.80
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | GRACE IQBAL |
| Role on the policy | Subscriber |
| Policy | B07M000730 |
| Date of birth | 1 Oct 1951 |
| Plan | PLATINUM PPO |
| Covered from | 26 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 133.80 |
| Total | 133.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003019 | 22 Feb 2024 | 892.00 | NORTHSTAR MUTUAL | Not denied | — |